The current study examined the role of two different methods of sign presentation on signed and spoken language acquisition of toddlers aged two to four years with Down syndrome (DS). The aim of this study was to determine if a method commonly used by native signers/Deaf mothers (referred to in this study as signing to maintain joint attention (SMJA)) was more effective than the method commonly used by hearing mothers and speech-language pathologists (referred to in this study as the triangular method of signing). Both methods were compared in a within-subject design for effects on the participants’ total number of words signed and/or spoken, unique words signed and/or spoken, and parent report of novel word acquisition. Although the sample size was small, clear trends were seen suggesting SMJA may result in greater increases in early language acquisition for toddlers with DS. These results are consistent with considerations regarding the DS phenotype. The use of signing takes advantage of strengths in gesture and visual-spatial short-term memory. More specifically, the use of SMJA addresses weaknesses in attentional capacity by allowing the child to attend to the object and referent without disruption, thereby maintaining joint attention and supporting language acquisition.